Kashmir: Violence and mental health
A cessation of hostilities, with a reduction in fear and intimidation will result in an immediate improvement of the population's physical situation.
During the last decade, the population of Indian Kashmir has been witness and victim of violence and this has had severe consequences.
House raids, searches, roundups, property damage and the burning of homes create an atmosphere of insecurity. Humiliations, threats, as well as physical and psychological abuse contribute to a profound feeling of lack of safety among the Indian-Kashmir population. Many people lost family members as result of the violence.
These are some of the findings of a quantitative research study undertaken by Médecins Sans Frontières (MSF) to examine the impact of violence on the Kashmiri population's psychosocial and general physical health.
Violence (or the threat of physical or sexual violence) appears to have a large impact on the population's psychological health. It leads to anxiety, fear, exhaustion and suicidal thoughts.
The mental health problems in Kashmir must be urgently addressed. In places where MSF is working, its teams offer mental health care. However, in the rest of Kashmir there are no facilities that offer such care. MSF is urging the authorities to prioritize providing mental health throughout Kashmir.
The ongoing conflict-related events cause substantial suffering in the Kashmiri population. Once Kashmir was referred to as 'Paradise on Earth' - our findings show clearly that for many Kashmiris, it has become rather a nightmare of constant fear that affects all areas of life.
The impact on the physical and mental health and socio-economic functioning is alarming. Our data shows a level of despair and lack of future perspectives that potentially endangers the longterm well being of many people (or worse, as many respondents had thoughts about committing suicide). Schooling and economic activities have suffered. Despite the political détente, violations of human rights and infringement of civilian rights by all fighting parties continue.
A cessation of hostilities, with a reduction in fear and intimidation will result in an immediate improvement of the population's physical situation. However, the effects of conflict do not always end the moment a peace agreement is signed. Many people will need some support to reduce their dependency on aid. Using a validated screening tool, we have shown that a substantial number of people suffer from serious psychological distress. Physical and mental coping mechanisms are exhausted, and the health system needs further strengthening.
The substantial needs for psychological and psychiatric support we identified in our survey can only be addressed through a strong community-based mental health system. This type of service is advocated in the Indian Mental Health Policy,34 but in Kashmir, community psychosocial services are absent and psychiatric services outside Srinagar remain non-existent.
The failure of the Ministry of Health to implement its own Mental Health Policy in Kashmir and many other parts of India35 contributes to increased and unnecessary suffering. Due to lack of services and/or medication, severely disturbed and ill people must travel long distances to seek care. The psychiatric hospital in Srinagar provides basic care and the number of patients is growing.36 Others suffer in silence.
MSF asks the authorities to implement their own policies. Psychosocial support (including counselling) in the villages is needed, with basic psychiatric support, including medication, at health post level. MSF calls on the health authorities to give a high priority to the region of Kashmir.
The findings of our survey show a serious mental health situation that is likely to have further deteriorated due to the recent earthquake that devastated some Kashmir districts. The mental health condition of the people must be given much greater attention.